[Treatment of congenital tracheal stenosis. Retrospective study of thirteen cases]

Thirteen cases of congenital tracheal stenosis (CTS) were retrospectively studied in terms of operative indication and treatment. The intratracheal transverse ratio of the stenotic/normal diameter (stenotic ratio, SR) was obtained by chest X-ray, tracheogram or autopsy, as one of the parameters of stenosis. SR ranged from 0.14 to 0.50 (mean 0.35 +/- 0.13 SD). Two cases (SR = 0.14) received tracheal resection and reanastomosis successfully. In three cases with pulmonary artery sling (PAS), PA translocation was performed to release tracheal compression. One (SR = 0.49) had good result but two (SR = 0.20, 0.30) died from respiratory failure (RF) and autopsy revealed PAS. Four cases underwent surgery for congenital heart disease (CHD), 3 (SR = 0.41, 0.46, 0.49) had good results but one (SR = 0.36) died from RF. In four cases medically treated, 3 (SR = 0.40, 0.44, 0.50) improved with growth but one (SR = 0.25) died before operation due to RF and autopsy revealed PAS. When SR greater than or equal to 0.40, cases without PAS improved with conservative treatment, those with PAS improved by PA translocation, and those with CHD tolerated open heart surgery. When SR less than 0.40, tracheal reconstruction is indicated. Cases with PAS would require primary or staged operation of PA translocation + tracheal reconstruction. The most appropriate therapy should be selected on the basis of symptoms, associated diseases and parameter of tracheal stenosis, for instance "SR".